OBR Daily Commentary

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Facing Criticism, CVS May Modify Its New Cost-Effectiveness Program For Covering Some Drugs

(STAT Plus) Sept 18, 2018 - CVS Caremark may revisit a plan that allows its clients to exclude coverage of most new, high-priced drugs after advocacy groups complained the effort would discriminate against very sick or disabled patients.

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William McGivney, PhD (Posted: September 25, 2018)

quotes C-VICER: CVS Embraces ICER We have reached a very sad time when a major corporation (CVS Health) embraces and is willing to integrate the skewed and obtuse work products of the pedantic ICER into treatment coverage decisions about patients diagnosed with cancer. It is always interesting to see companies willing to limit access while wanting at the same time to have a third party to point the finger at. Instead of proceeding, I will quote an important article from OBR Green published on October 19, 2016. After reviewing the ICER analysis on Non-Small Cell Lung Cancer, five eminent lung cancer docs stated: “ICER appears to represent a perspective that is less oriented towards patient benefit than towards motivations that would limit patient access to therapeutic options. ICER’s clinico-economic methods include approaches and metrics that, due to their singular focus on population health, would likely fail patients on an individual clinical needs basis. ICER’s philosophy appears to be similar to that of NICE in the UK, whose limitations placed on drug access have been correlated with lower cancer survival rates in the UK compared to the rest of Western Europe.” “For us as practicing oncologists and lung cancer researchers, this report has raised serious concerns regarding ICER’s ability to interpret clinical evidence and reach conclusions on drug value that are scientific, comprehensive and unbiased.” Enough said! quotes

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Medicare Advantage Plan Proposed Use Of Step Therapy For Part B Drugs

(Forbes) Sept 17, 2018 - Payers must balance patient access to biopharmaceuticals and cost containment. A public payer such as Medicare and its contractors is no different in this regard.

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William McGivney, PhD (Posted: September 17, 2018)

quotes “Your First Chance is Your Best Chance” The title used to be the tagline for some of the advertisements of Memorial Sloan Kettering. CMS has either not heard or dismisses such considerations given the recent announcement to allow Medicare Advantage Plans to enact Step Therapy programs for Part B agents. As quoted in the Forbes article, “Step therapy is controversial. It is the most onerous condition of reimbursement in that it defers certain treatments until a later point in time”. It all just seems to get worse and worse for physician autonomy and patient well-being. Does CMS not see the distinct possibility in this program of actually increasing the variability of Medicare beneficiaries’ access to therapies given that it is quite likely that MA Plans will have Step Therapy Programs that will differ, one from the other? Will MA Plans deftly handle Part B to Part D stepping processes with a lack of understanding of patient likelihood of non-adherence under Part D. What will implementation of such a Program do to personalized medicine with biomarker-directed care? How long will such step therapy policies delay drugs/biologics for patients in need? The list of concerns goes on and on! An NCCN Panel Chair recently told me the story of that person’s latest “peer to peer” discussion with a payer. When the Payer’s cardiology nurse finished misquoting the relevant NCCN Guideline, the Panel Chair told her that she/he was actually the Chair for that Panel and cited the page and line that justified the use of the drug in question. How will a patient’s first chance be guided with this “most onerous condition of reimbursement” being applied by well-meaning cardiology nurses? quotes

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Potential Administrative Burdens in Oncology Clinical Pathways

(Journal of Clinical Pathways) May 7, 2018 - A recent review of prominent pathway vendors revealed that most vendors met the key ASCO criteria for being expert-driven, patient-focused, up to date, and comprehensive.

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William McGivney, PhD (Posted: May 11, 2018)

quotesCoincidently, I was lecturing last week at the Home of Guideline study, Dartmouth (at the Tuck Business School). I talked about how studies in the 1980s by Drs Wennberg, Zubkoff, and others argued for the establishment of national guidelines. Why? The goal was to diminish the substantial variation of physician practice and recommendations for different reasons in regions across the country. Thirty years later, we now have a (dare I say) bastardization of that principal as described in this article. Payers, health plans, MCOs, etc. require their own selected and favorite pathways that may differ across each patient frequently in terms of recommended treatments, including preferred treatments. Oncology practices must juggle multiple, disparate recommendations depending on the insurance that a patient may carry or that MCO picked by a payer to manage that patient. The circumstance of the multiple guideline/pathways recommendations that oncology practices have to juggle belies the concept of a National Guideline that unifies and directs best patient care. Anybody ever hear of the letters NC? quotes

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Meet the Editorial Board

Prostate Cancer
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Tomasz M. Beer, MD, FACP

Professor of Medicine, Division of Hematology/Medical O...

Community Oncology
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Dean Gesme, MD

FACP FACPE FASCO President, Minnesota Oncology...

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Debu Tripathy, MD

Professor and Chair, Department of Breast Medical Oncol...

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H. Jack West, MD

Medical Director, Thoracic Oncology Program, Swedish Ca...

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Howard S. Hochster, MD

Distinguished Professor of Medicine, Rutgers Robert Woo...

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Howard Sandler, MD, MS, FASTRO

Ronald H. Bloom Chair in Cancer Therapeutics
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Jeff Patton, M.D.

CEO Tennessee Oncology...

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Jennifer Levin Carter, MD, MPH

Chief Medical Officer and Founder, N-of-One...

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Michael G. King Jr.

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Richard Goldberg, MD

Director WVU Cancer Institute Director of Cancer Signa...

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Robert A. Figlin, MD., FACP

Professor and Director, Division of Hematology Oncology...

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Ted Okon

Executive Director Community Oncology Alliance...

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Thomas Marsland, MD

Vice President Integrated Community Oncology Network ...

Community Oncology
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William Harwin MD

Florida Cancer Specialists President and Managing Part...

Health Policy
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William McGivney, PhD

National Health Policy Expert...

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Winston Wong, PharmD

President, W-Squared Group...